NPIMap

Organization Active NPI

Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • San Anselmo, CA
National Provider Identifier
1639996408
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARIN COMMUNITY CLINIC
Practice address
1327 Sir Francis Drake Blvd
San Anselmo, CA 94960-1800
Phone
(415) 798-3133
NPI assigned
Sep 24, 2024
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Farhan Fadoo, MD
Title
Chief Executive Officer
Phone
(415) 755-2581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1327 Sir Francis Drake Blvd
San Anselmo, CA 94960-1800

Mailing address

9 Commercial Blvd Ste 103
Novato, CA 94949-6118
Phone (415) 798-3133

Other names 1

  • Archie Williams High School Other name

National Provider Directory

National Provider Directory
Tax ID family
Marin Community Clinic16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

1327 Sir Francis Drake Blvd
San Anselmo, CA 94960
Phone (415) 798-3133

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1639996408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 COMMERCIAL BLVD STE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496118",
            "telephone_number": "415-798-3133",
            "fax_number": "415-798-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 SIR FRANCIS DRAKE BLVD",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949601800",
            "telephone_number": "415-798-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-24",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "FADOO",
        "authorized_official_first_name": "FARHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-755-2581",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Archie Williams High School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Anselmo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.